Claims Analyst

How you will make an impact

• Review and analyze healthcare claims for accuracy, completeness, and eligibility.
• Ensure claims are processed in accordance with company policies, procedures, provider contracts and regulatory requirements.
• Verify patient and provider information and validate claim codes (ICD, CPT, HCPCS).
• Identify discrepancies and inconsistencies in claims and take appropriate corrective actions.
• Communicate with healthcare providers, patients, and insurance companies to resolve claim issues.
• Investigate and resolve denied or rejected claims.
• Accurately enter claim information into the claims management system.
• Maintain detailed and organized records of claims and related correspondence.
• Prepare and generate reports on claim status, trends, and performance metrics.
• Stay updated on industry regulations and guidelines related to healthcare claims processing.
• Ensure compliance with HIPAA and other regulatory standards.
• Participate in quality assurance reviews to identify areas for improvement and implement best practices.
• Work closely with the Director of Provider Operations and other team members to improve claim processing workflows.
• Provide training and support to new team members as needed.
• Communicate effectively with internal and external stakeholders to facilitate smooth claims processing.

What we are looking for

• Minimum of 5 years of experience in healthcare claims processing or a similar role.
• Familiarity with medical terminology, claim coding (ICD, CPT, HCPCS), and insurance billing practices.
• Strong analytical and problem-solving skills.
• Excellent attention to detail and accuracy.
• Proficiency in using claims management software and Microsoft Office Suite.
• Effective communication and interpersonal skills.
• Ability to work independently and as part of a team.